Death of A Social Security Beneficiary

Name of deceased:

Last Name of deceased:

Last 4 digits of Social Security Number (SSN):

Date of Death:

Date of birth:

Reporters Information

Name and Last Name of reporter:

Relationship to deceased:

Mailing Address (not in U.S.):

Phone Numbers (add Country Code if not in UK):

1) Daytime Phone

2) Evening Phone

3) Mobile / cell

Your email address:

Additional Information:

The information you provide is used solely by the Federal Benefits Unit of the U.S. Embassy London. In order to process certain types of requests, we may have ask for your Social Security Number (SSN) or the last 4-digits thereof, your date of birth, or your banking information. You may decline to provide such information, but that could inhibit our ability to answer your questions or assist you with your request. Any information provided on our web form is not retained and is used only in order to process your current request or answer your current questions. The London FBU Office works in accordance with SSA procedures as well as the Paperwork Reduction Act (44 U.S.C. 3501 et seq.) and the Privacy Act of 1974. You can read our full privacy statement at http://www.socialsecurity.gov

U.S. Embassy & Consulates
in the United Kingdom

Certification of Death